Immigraton,Retugees Immigration, Refuge and iizenship Canada et Ctoyenneté Canada [Save | [ Resto |[_rrnt Farm i+ USE OF A REPRESENTATIVE ‘You donot need tire a representative ls your cholee, No ane an guarantee the approval of your application. All he fms andinfmation that you need | to apply are avalable for ree at yi.ce-0.c8. ‘A representative is someone who has provided advice or guidance to you al any stage ofthe application proces, whether that person recsived consideration (ie. componsation) or not Folowng the submission of your appliaton, that person may conduct business on your behal wih immigraton, Refugees and Citzenstip Canada (IRC) andthe Canada Border Services Agency (CBSA) I you appoint the as your representative by ng out this orn. The preceding Incses Express Enty submssions. You may have one reproseniatve onl per applicator. If You sppont an adatonal represerative, the previous ‘representative wl longer be authorizes to conduct business en your behal and receive inrmaton on yeu case fe ‘Note: You must use tis form o appoint pss cr unpaid representative to conduct business with IRCC or the CBSA on your bel You must alo us hs ‘orm ot notify IRGC your repteaentatve'a contact nlralion changes, 2 if you wish o cancel the appotment of your curent representative and Tepresent yours 3. 1you wish fo cancel the appainiment of your curent representative and appoint anew representative ‘pointing a representative. Complete Sections A, B and D. [1 canceting the appaintment of a representave. Complete Section A Cand D. ‘SECTION A: APPLICANT INFORMATION i 1. Your fullname Fam name (Sumaie) ‘Given namete) frroxierna, louexsaNoea. 2. Your date of bith (YYYY-MWV-DD) ae 2. Ifyou have already submitted your application: me of office where te spplcation was subsite “Type of spoon permanent residence exersion of study permet) lun fern 4. Unique Client Identifier (UCI) number (flown) faza ‘SECTION B: APPOINTMENT OF REPRESENTATIVE autre the following individual to serve a8 my reresertave and to conduct business on my behalf wih immigration, Refugees end Ciizonship (Canada and Canada Borer Services Agency, Note: Even ia reproseniave is being pad or compensated by someone oer than you (he SppEcan), the representative esl considered fo bo a compensated represertave «authorize immigration, Refugees and Cizenship Canada and Canada Border Services Agency to release information from my case le and hat of my tependent Sulton Lnder 18 years of age to my representative, Ths authorzation isin accordance wih the Privacy Act. «em aware thet ery information which would be abject te exemption, had the right of access under the Privacy Actor he Aczeaaf infomation Act wily not be released 5, Your representative's fll name amily name (Suma) ‘Given name(s) TAUREN lanoRew 6. Your representative tick one box: (is UNCOMPENSATED an [Zend or tamiy member rember ofthe Calle of nmigration and Citzenship Consultants (CICC), 7 potas du Qudbec which province or [J otrer (pease spect) sera (12021) ‘[SECTION D: YOUR DECLARATION 40. Your declaration * [declare thet have uty and rutfly answered all ostons on this frm and any atachod appicaton (applicable). have read and understood all the statements on his form, having asked and abtined en explanation for every point that was not ¢ i 2022-05-10 SIGHS oT appa Daa 7PYV-MN-ODT ‘Signature of spouse ar commit aw parnar Tor Sponsorship aplcaion ae VYYIUEDDY Waring! itis 2 serious offence to give false or misleading information on this form, Personal information provide on ths form I coleted by immigration, Refugees and Citzanehp Canada (FRCC) under the author of he Immigration and FRefagee Protection Act (IRPA) and ofthe iiznship Ac. The persona formation ofthe appean is vee for ientieaion and auhorzaton purposes. The personal nfonaton ofthe immigration representatives used to very tat the represetatve Is auhorized to offer representation serdces accoring tthe Provisons of IRPA and ofthe Cizenship Act ‘The personal information of both the applicant and the represantatva may be declosed to other faderal government inetutons, nn-gavemmental and inte governmental ocgenizatons, regulator bodes, investigaive bodies, nd prvinclaleriteral governments forthe purposes of validating lant, information, land supporing an investigation Personalinformation ofboth he applicant andthe representative may be used for he purposes including research, stalstcs, program and poley evaluation, Inlemal aud, compfance, risk management, sratogy development and reporting. Flue to complete the fom in fu wil recut ina delay to processing. The Priacy Ac gves individuals the right of seces o, protection, and caecton of thelr personal infomation. Ifyou are not sacred wih the manner in which IRC handle your personal information, you may exarcze your right le 8 complaint tothe Office ofthe “The collection, ue, declosure ane retention of your personal normaton i further described Privacy Commissioner of Canada, in IRCC's Personal vermation Bank -IRCC PPU 013, 042,054,068.‘OR (is, or wat , COMPENSATED and iss member in good standing of [tne cotege ot immigration and ciizenship Consultants (CICC) Membership 1 number Oo Canadian provincial or torial iw society Which prvines or terlon’? Monborsip ID numbor the cambre des notares du Québec lembership ID number tou orien ee ttm arznon apa) Sl re senile nanioip [va eis ons. AVE Roisin Gano oar Ponds es =) feasaon ee 284 Teton nba coy Goin vo Cais a Tata lor (ale) 272 43 61 noe um Cole___ ea Code and Talons uber ms | ral acs apa) =| Gndter iaurenesstioo com y nicaing your representative's e-mail adores, you are hereby authrzing migration, Refugees and Chizenship Canada to transmit your fle and personal fomaton ta tis specie emai adress. ‘Your representative's declaration: clare that he information ln Section Bis tru, complete and comes +L understand and accept that am the person apponted spent nc ba oe et ase wh i Reftagess and Cilzenshp Canada and Canada Border Senses Agency. wthdraw my autora or ie, preon 0 sre as my represent, force Immigration, Refugees and Ctizenship Canada and Canada Border Services 9. Your representative's fullname